The U.S. Supreme Court's ruling upholding the heart of President Barack Obama's health care overhaul aimed at uninsured people also ensures that Republicans will highlight their continued opposition for the fall campaign in the pivotal state of Ohio.

The state's former Democratic governor said the Republican opponents risk alienating Americans who will benefit from the changes. Ted Strickland, an Obama campaign co-chairman, also called Thursday on his Republican successor's administration to get moving on a state health care exchange under the law.

Gov. John Kasich and Lt. Gov. Mary Taylor issued a statement saying they were analyzing a court ruling they found disappointing and are concerned about dramatically higher costs it could mean in the state for Medicaid and other coverage.

"This matter will now be fought out in the political arena, again," said Attorney General Mike DeWine, a Republican. "It makes this issue the pre-eminent issue of the presidential campaign. ... People will have the ability this fall to do what the United States Supreme Court would not do today, and that is to repeal Obamacare."

The race between Obama and Republican Mitt Romney is expected to be close in Ohio, a swing state likely to be crucial to Romney's chances of winning the general election. Republican Sen. Rob Portman said that Ohio voters have already expressed their opposition to the law and that health care is "one of the issues that will help decide the election in Ohio, and therefore around the country."

Ohioans voted heavily against the overhaul's mandated coverage in a largely symbolic referendum last year, and statewide polls this year continue to indicate most Ohioans are opposed to the health care law.

"It gives Romney a target if Ohioans continue to not like the health care law," said Peter Brown, assistant director of the Quinnipiac University Polling Institute.

Brown said the decision was a boost to Obama's re-election campaign because it allowed his signature legislation to stand. He said some Ohioans might now think the law is acceptable since it has been to the Supreme Court, but it's too soon to tell.

"Over the next four months, the question is can Romney essentially make lemonade out of lemons," Brown said in an interview. "And that's really the unknown question."

Former Gov. Strickland said Republicans are focusing on opposing Obama instead of the issues of 30 million uninsured Americans - some 1.5 million in Ohio - and sick people with pre-existing conditions.

"These people puzzle me," Strickland told The Associated Press. "They keep talking about repealing and replacing, but they're not talking much about the replacing part.... They have no answers."

DeWine, a Republican, said the state will continue to be part of a lawsuit disputing the health care law on the grounds it compels people to violate their religious principles, and U.S. House Speaker John Boehner, R-West Chester, pledged to work for its repeal.

Columbus Mayor Michael Coleman, a Democrat, applauded the ruling and said it will lead to expanded community health services, access to coverage for the uninsured, and for sick people with preexisting conditions.

"This is a victory for the American people," Coleman said in a statement.

Kasich's administration hasn't moved to create a state health care exchange, saying it has been evaluating options and seeking more clarity from the Obama administration. Tayor, who serves as state insurance director, has frequently criticized the overhaul.

"I think we find ourselves well behind most other states," Strickland said. "So she needs to stop talking and go to work and pull together the kind of efforts that's going to be necessary to get these exchanges up and running."

State Rep. Nickie Antonio, D-Lakewood, said she would continuing pushing on the state exchange. She sponsored a bill to provide coverage options for individuals and include an exchange for individual coverage and a Small Business Health Options Program for small business owners to provide coverage for their employees.

"I have met with many stakeholders from Ohio who know that setting up a state exchange ... will bolster a competitive market place where all Ohioans will have access to affordable health care coverage," Antonio said.

State Sen. Larry Obhof, R-Medina, said the decision could mean "significant long-term difficulties" for Ohio, adding budget pressures by requiring billions of dollars in additional funding.

Meanwhile, the nonprofit Health Foundation of Greater Cincinnati said its surveys have indicated most Ohioans don't understand how the health care changes will affect them personally, and it urged people to seek information on sections of the law that have already taken effect and what will happen in the future.